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Structural interplay of anesthetics and paralytics on muscle nicotinic receptors

Author

Listed:
  • Umang Goswami

    (University of Texas Southwestern Medical Center)

  • Md Mahfuzur Rahman

    (University of Texas Southwestern Medical Center
    Thermo Fisher Scientific)

  • Jinfeng Teng

    (University of California, San Diego)

  • Ryan E. Hibbs

    (University of Texas Southwestern Medical Center
    University of California, San Diego)

Abstract

General anesthetics and neuromuscular blockers are used together during surgery to stabilize patients in an unconscious state. Anesthetics act mainly by potentiating inhibitory ion channels and inhibiting excitatory ion channels, with the net effect of dampening nervous system excitability. Neuromuscular blockers act by antagonizing nicotinic acetylcholine receptors at the motor endplate; these excitatory ligand-gated ion channels are also inhibited by general anesthetics. The mechanisms by which anesthetics and neuromuscular blockers inhibit nicotinic receptors are poorly understood but underlie safe and effective surgeries. Here we took a direct structural approach to define how a commonly used anesthetic and two neuromuscular blockers act on a muscle-type nicotinic receptor. We discover that the intravenous anesthetic etomidate binds at an intrasubunit site in the transmembrane domain and stabilizes a non-conducting, desensitized-like state of the channel. The depolarizing neuromuscular blocker succinylcholine also stabilizes a desensitized channel but does so through binding to the classical neurotransmitter site. Rocuronium binds in this same neurotransmitter site but locks the receptor in a resting, non-conducting state. Together, this study reveals a structural mechanism for how general anesthetics work on excitatory nicotinic receptors and further rationalizes clinical observations in how general anesthetics and neuromuscular blockers interact.

Suggested Citation

  • Umang Goswami & Md Mahfuzur Rahman & Jinfeng Teng & Ryan E. Hibbs, 2023. "Structural interplay of anesthetics and paralytics on muscle nicotinic receptors," Nature Communications, Nature, vol. 14(1), pages 1-10, December.
    • Handle: RePEc:nat:natcom:v:14:y:2023:i:1:d:10.1038_s41467-023-38827-5
    DOI: 10.1038/s41467-023-38827-5
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    References listed on IDEAS

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    1. Jeong Joo Kim & Anant Gharpure & Jinfeng Teng & Yuxuan Zhuang & Rebecca J. Howard & Shaotong Zhu & Colleen M. Noviello & Richard M. Walsh & Erik Lindahl & Ryan E. Hibbs, 2020. "Shared structural mechanisms of general anaesthetics and benzodiazepines," Nature, Nature, vol. 585(7824), pages 303-308, September.
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